Financial

July 08, 2011

People with disabilities from across the country watched, listened to, and questioned AAPD's new President and CEO in our first ever Virtual Town Hall on June 29. The event was also live tweeted at @AAPD. If you were not able to participate on the day of the event, you can still watch and listen to the event which has been captioned and posted to YouTube. Topics of discussion included voting, employment, Medicaid cuts, and more. Viewers asked questions about getting involved in the legislative and electoral processes and how to improve educational access for kids with disabilities. The discussion was lively and informative. Furthermore, Mark shared his vision for our organization and his plan include more town halls. So check out this event and check back for information about the next town hall.

This month marks the 12th anniversary of the Supreme Court’s landmark decision in Olmstead V. L.C., ruling that the needless institutionalization of people with disabilities is illegal discrimination. Despite that decision, misguided Medicaid rules continue to force millions of people with disabilities to remain in nursing homes, against their wishes and at a much greater cost to taxpayers than many home and community-based alternatives.

Today, as we seek ways to reduce budget deficits, we must seize on the opportunity to make our Medicaid dollars go farther while finally giving millions of individuals with disabilities one of the most fundamental of rights: the choice to live independently.

The Olmstead decision is sometimes called the Brown v. Board of Education for people with disabilities. It questioned the widespread practice of forcing people with disabilities to live in segregated settings in order to receive services, and it opened the door for people with disabilities to live full lives and participate in their communities.

Adhering to the ADA’s “integration mandate” not only allows people to live the same kinds of lives that the rest of us do, but actually saves money...

AAPD recently learned about a new program by theU.S. Department of Housing and Urban Development (HUD). In conjunction with NeighborWorks® America, HUD announced the launch of the Emergency Homeowners’ Loan Program (EHLP).

The EHLP is designed to provide mortgage payment relief to eligible homeowners experiencing a drop in income of at least 15 percent directly resulting from involuntary unemployment or underemployment due to adverse economic conditions and/or a medical emergency.

Under the EHLP program guidelines eligible homeowners can qualify for an interest free loan which pays a portion of their monthly mortgage for up to two years, or up to $50,000, whichever comes first. Eligible homeowners must have current income at least 15% less than it was in 2009 and must be at least 90 days delinquent on the mortgage, among other eligibility factors.

For instance, you must have received a written notice from your mortgage lender/servicer indicating that you are delinquent on your first mortgage payments, referred to as a “Breach Letter.” Also, you cannot be in bankruptcy or owe unpaid federal income taxes or have unpaid federal student loans, among other criteria.

Possible loss of a house is one of the number one phone calls involving people with disabilities that we hear about at the AAPD national office. If you or someone you know is experiencing mortgage difficulties due to the continuing economic situation, explore if the EHLP program can help. Why lose your home through failing to check out a program and fill out the necessary paperwork?

There’s been a number of news articles recently stating that CMS will track hospital spending for Medicare recipients and will reward hospitals that keep costs down and penalize hospitals for costs incurred within 90 days after the person leaves the hospital.

It’s a “Medicare spending per beneficiary” device to measure hospital performance. For example, we have national data for infections occurring after surgery and/or as a result of just being in a hospital. Hospitals with much higher rates will be penalized. Similarly, there’s national data for heart attack mortality rates against which hospitals can be compared, rated, and then rewarded or penalized.

Obviously, besides improving medical care, rewards/penalties are an important strategy to control health costs, something everyone agrees is necessary.

We have a simple suggestion for CMS.

How about CMS including in its “Medicare spending per beneficiary” the measure of placement in nursing homes directly from acute care hospitals? This could actually be easily implemented because CMS could actually enforce its own federal regulations which require hospitals to do real and meaningful “discharge planning”?...

CMS - you have a financial interest, the regulatory authority, as well as an interest in the ADA’s mandate that services be provided “in the most integrated setting appropriate,” to address hospital dumping.

Include in the “Medicare spending per beneficiary” plan a measure of post-hospital placements. Reward hospitals that place people in the community with services and penalize hospitals with the worst dumping scores.

June 24, 2011

Reduced Federal Medicaid Payments in 2012: Many States Already Cutting Back

By David Heymsfeld, AAPD Policy Advisor

In recent weeks supporters of Medicaid have focused on advocating against proposals, such as block grants and global spending caps, which could lead to drastic reductions in future federal funding of Medicaid. The threats of these proposals have obscured the fact that even if none of these proposals are enacted there are provisions in existing law which will result in less spending for Medicaid in 2012 than in 2011. In many states this is likely to lead to reduced Medicaid services including for people with disabilities and their family members.

Background: In the Medicaid program, each state establishes its own program although it must work within federal requirements. The federal government helps fund each state’s program, with the federal share averaging about 57%. Medicaid is the largest expense in state budgets, and constituted about 22% of total state spending in 2010.

Federal Cutbacks Taking Effect on July 1, 2011: As you may recall, there was legislation passed in 2009 to combat the recession, that is, the American Recovery and Reinvestment Act, also referred to as “the stimulus.” This temporarily increased the federal share for Medicaid by about 10%, resulting in the states receiving about $87 billion in increased funding. This increased rate of funding ends on July 1, 2011. However, at the same time, the needs are growing. For instance, as a result of the recession, Medicaid enrollment increased by 8% in 2010, with estimated growths of 5% in 2011 and 4% in 2012.

With federal funding to be reduced by 13% in Fiscal 2012, most states are planning some increases in their own funding, but not enough to close the gap. Overall Medicaid funding is expected to decrease 3%. With the lower funding, most states are planning some changes to limit costs of their programs.

How States Cut their Medicaid Programs: These changes include reduced provider payments in 33 states, making it more difficult for Medicaid patients to find providers willing to treat them. Other measures include limitations on benefits to be carried out in 25 states. Another 13 states will put limitations on prescription drugs. New or higher co-payments will occur in 21 states and there will be expansions of managed care in 19 states. In fact, many states are proposing more than one of these changes. For instance, Table 29 (page 57) lists which states have cut or plan to restrict community-based care (CA, MN, NY, WA).

Note that the so-called Maintenance of Effort (MOE) provisions included in the health care reform Act prevent the states from making other changes such as increasing income eligibility levels or otherwise making it more difficult for individuals to apply.

This will give you some sense of what your state is looking at in regard to Medicaid. For instance, Table 28 shows some specific strategies states are using. Note also that the states are considering ways to increase revenues (Table 30).

Contact your governor’s office or state legislator to learn about specific proposals to cut back Medicaid in your state.

Protest early and often any cuts that are unfair to people with disabilities or revenue enhancements that unfairly burden people with disabilities and their families.

WASHINGTON – The Department of Justice released a new technical assistance document describing public entities’ obligations and individuals’ rights under the integration mandate of title II of the Americans with Disabilities Act (ADA) and the 1999 landmark Supreme Court decision, Olmstead v. L.C. The Olmstead decision held that the ADA requires public entities to provide community-based services to persons with disabilities when such services are appropriate; the affected persons do not oppose community-based treatment; and community-based services can be reasonably accommodated. The document also provides questions and answers on a variety of ADA enforcement issues related to Olmstead.

Additionally, in commemorating the 12th anniversary of the Olmstead decision yesterday, the department launched a new section of its ADA website, www.ada.gov/olmstead, providing information and resources about the decision and its enforcement. In addition to the newly created technical assistance document, users can visit the site to find briefs filed by the Department, as well as other materials relevant to this important area of law.

The ADA website provides easy access to an extensive collection of ADA technical assistance materials and settlement agreements, as well as information about enforcement, mediation, technical assistance and certification activities and links to other sites with ADA information. The addition of the new Olmstead section of the site will provide critical information to individuals with disabilities, advocates and state and local officials responsible for complying with the ADA’s integration mandate...

June 23, 2011

The memories of living in institutional settings since the age of 13 will always be with Lois Curtis even though her life today is beyond what she ever could have imagined when she made the first of many brave phone calls to my office at the Atlanta Legal Aid Society saying, “I want to get out!” The journey (and struggle) from that day includes an historic Supreme Court decision, a home of her own and a successful career as an artist. And now, a meeting with President Barack Obama in the Oval Office as we observe the 12th anniversary of the Olmstead decision.

The Olmstead story began long before the Supreme Court decision. Lois and another plaintiff, Elaine Wilson (who passed away in 2004), were in a state psychiatric hospital in Georgia. They filed suit in 1995 seeking disability services in the community...

...And, as we all now know, the U.S. Supreme Court eventually held that the unjustified institutional isolation of people with disabilities is a form of unlawful discrimination under the Americans with Disabilities Act, thus taking a giant step forward for the millions of people with disabilities across the country.

Lois’ story did not end after that landmark Supreme Court decision. In fact, that decision launched a new journey. After living in staffed residential homes since her release from the institution, Lois now rents a beautiful home in the Stone Mountain area of Georgia...

June 22, 2011

ADAPT Calls on Washington and the States to Endorse Real Medicaid Reform that Protects the Civil Rights of Seniors and People with Disabilities

June 22nd is the anniversary of the landmark Supreme Court decision in Olmstead, which applied the integration mandate of the Americans with Disabilities Act (ADA) to long term services and supports. In that decision, the Supreme Court affirmed that people with disabilities have a civil right to live in the community in the most integrated setting. Twelve years later, members of Congress and state governments are trying to de-fund that right by cutting Medicaid and giving states “flexibility” to cut programs that assist people with disabilities and seniors to live in their own homes and communities.

In response to these harmful federal proposals, ADAPT is launching a campaign for real Medicaid reform that protects people’s liberty in every state of the country. Over the next few months, ADAPT and other disability organizations are mobilizing their members to visit their Congressional and state representatives and organize events in Washington DC and every state. “We need to remind these federal and state policy makers that de-funding Medicaid de-funds our freedom and that is not acceptable,” said Rahnee Patrick, ADAPT Organizer from Chicago.

While Congressional Democrats have vowed to protect seniors and nursing facilities, their current proposals also cut vital home and community-based services that allow seniors and people with disabilities to stay in their own homes. “Congress and state governments need to recognize that the freedom of Americans with disabilities and seniors is a civil rights ‘entitlement’ that they shouldn’t eliminate or diminish,” said Bruce Darling, ADAPT Organizer from Rochester, NY.

The campaign will be highlighted with a rally in Washington DC on Capitol Hill, Wednesday September 21st. ADAPT and the other campaign organizers are urging disability, senior and civil rights organizations in every state to hold their own events this summer and immediately begin working to bring people with disabilities and older Americans to our nation’s capital in September. For more information on the rally, go to ADAPT’s website at www.adapt.org.

ADAPT continues to meet with Congressional representatives and identify ways to contain Medicaid spending that implement people’s right to live in the community and save taxpayer dollars at the same time. These proposals include:

Expand the use of community-based services. Studies have demonstrated that by reducing the over-reliance on institutions and nursing facilities and shifting toward more cost-effective community-based services, states can contain Medicaid spending. Despite the growing body of evidence showing that community-based services are more cost effective, the federal government still allows states to continue their wasteful, institutionally-biased practices...

June 21, 2011

New Study Reveals that National Average Rents are Higher than Supplemental Security Income Payments Received by People with Disabilities

Vulnerable People with Disabilities Completely Priced Out of Nation's Housing Market

Washington, D.C. -- The national average rent for a modestly priced one-bedroom apartment is more than the entire amount of Supplemental Security Income received by people with disabilities, according to a new study released today by the Consortium for Citizens with Disabilities Housing Task Force and the Technical Assistance Collaborative.

The study, titled Priced Out in 2010, reveals that as a national average, people with disabilities living on Supplemental Security Income (SSI) needed to pay 112 percent of their income to rent a modest one-bedroom unit priced at the fair market rent. Rents for smaller studio/efficiency apartments, were 99 percent of SSI..

SSI is a federal program that provides income to people with significant and long term disabilities who are unable to work and have no other source of income and virtually no assets. According to Priced Out, in 2010, a single person SSI household received an average monthly SSI payment of $703 to cover all their basic needs, including housing.

This study makes it crystal clear why vulnerable people with disabilities become homeless or are unable to move out of high-cost institutional settings, said Ann OHara of the Technical Assistance Collaborative, who co-authored the study. As this study shows, a monthly income of only $703 is less than the rent for most apartments, particularly in higher cost housing markets...

June 20, 2011

Making History for Students with Developmental and Intellectual Disabilities

by Rayna Aylward

As high school seniors all across the country graduated this week, history was quietly being made in Washington, D.C. at the Department of Education for 23 D.C. public school students with developmental and intellectual disabilities. They, like their peers across the country, were graduating too. They all participated in a program called Project SEARCH. The 15-year-old program now operates in 39 states and four foreign countries, but this is the first year that the federal government has hosted the project in three agencies including the Departments of Education, Labor and Health and Human Services.

The goal of Project SEARCH is to prepare high school seniors with developmental and intellectual disabilities for employment. Instead of attending classes in a regular high school, the participating students reported to work every day in one of the federal agencies. They received vocational training from a special education teacher for part of the day, and then worked as interns in different offices, learning skills that would prepare them for paid employment in the government or private sector. Job coaches who were part of the Project SEARCH team accompanied the students to their assigned offices to teach them the specific job skills needed to fulfill each task...

Frankie Mastrangelo is the moderator for both the Justice For All (JFA) national email listerv as well as for the JFActivist blog. She is also an organizer for the American Association of People with Disabilities in Washington, D.C.